RESUMO
BACKGROUND: Cervical malignancies are the leading cause of cancer-related morbidity and mortality among women in developing countries. Although early detection programmes using cytological methods, followed by aggressive treatment of precursor lesions are accepted as the main disease control strategy, fiscal limitations make this strategy unfeasible in many countries. METHODS: To screen selectively, we developed two risk scores using data from a population-based case-control study in Jamaica with 202 cases and 363 controls. Independent risk factors for cervical neoplasia were determined using logistic regression. An unweighted risk score for each subject was developed by a simple count of risk factors present and a weighted risk score was calculated by summing regression coefficients for each risk factor. RESULTS: Four patient characteristics were independently predictive of cervical neoplasia, older age (OR = 3.4, 95% CI : 1.8-6.7), > or = 4 pregnancies (OR = 5.6, 95% CI : 1.2-18.7), poverty (OR = 2.1, 95% CI : 1.3-3.3) and cigarette smoking (OR = 1.9, 95% CI : 1.2-3.2). Using cut-off points of > or = 20 for the weighted scores and > 3 for unweighted scores, the sensitivity and specificity were 65% and 69% for the unweighted score and 75% and 61%, respectively, for the weighted score. Areas under the receiver operating characteristic (ROC) curves for the weighted versus the unweighted scores were similar, suggesting similar overall accuracy. CONCLUSION: Selective screening using risk assessment strategies is potentially useful, particularly in resource-poor settings. However, whether weighting factors is essential is dependent on prevalence of factors in a given setting. Although this approach needs validation in other populations, women at highest risk for cervical neoplasia can be identified using demographic factors available during a regular clinic visit.
Assuntos
Neoplasias do Colo do Útero/etiologia , Adulto , Fatores Etários , Estudos de Casos e Controles , Feminino , Humanos , Jamaica/epidemiologia , Modelos Logísticos , Paridade , Pobreza , Valor Preditivo dos Testes , Prevalência , Curva ROC , Fatores de Risco , Fumar/efeitos adversos , Inquéritos e Questionários , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/epidemiologia , Esfregaço VaginalRESUMO
The frequency of injuries secondary to use of all-terrain vehicles (ATV) is increasing at an alarming rate, and these injuries are usually multiple and severe. Between January 1, 1983, and February 28, 1985, 415 pediatric patients were admitted to the University of Virginia Hospital for care of injuries secondary to trauma; 66 of these patients required intensive care. Of the 415 patients, 12 were injured secondary to ATV use, and four of these required intensive care. The average age was 12 years (range 2 to 16 years), and the average hospital stay was 20 days. Injuries included five closed head injuries, two associated with a basilar skull fracture requiring intracranial pressure monitoring; five long bone fractures, two requiring open reduction and internal fixation; two small bone fractures; two splenic ruptures; two liver lacerations, one of them requiring laparotomy; and one renal hematoma. One patient has required long-term rehabilitation for neurologic deficits. Physicians and the public should be aware of the injury potential of these vehicles and should advocate legislation promoting helmet laws and high safety standards for ATV users.